Video-Assisted Thoracoscopic Surgery (VATS) Periprocedural Care

Updated: Oct 21, 2016
  • Author: Doraid Jarrar, MD; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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Periprocedural Care

Equipment

Equipment for video-assisted thoracoscopic surgery (VATS) includes the following:

  • 5- or 10-mm video thoracoscope, with a 0º or 30º lens and a three-chip charge-coupled device video camera
  • Sponge-holding forceps
  • Long-blade diathermy pen
  • Endoscopic biopsy forceps (for simple pleural biopsy)
  • Endoscopic staple-transection devices (for lung wedge resection)
  • Rigid or flexible trocar cannula and/or sterile plastic bag
  • Thoracotomy tray
  • Chest tube drainage device with water seal
  • Suction source and tubing
  • Sterile gloves
  • Sterile drapes
  • Gauze squares
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Patient Preparation

Anesthesia

For most VATS procedures, general anesthesia with selective single-lung ventilation using a double-lumen endobronchial tube is preferred. Left-side intubation is usually performed unless a left pneumonectomy is anticipated. A single-lumen endotracheal tube with a bronchial blocker is an acceptable alternative.

For treatment of pleural effusions and sympathectomy, single-lung ventilation with low tidal volumes is a better option and allows adequate visualization of the pleural space. Moreover, COcan be insufflated to facilitate partial collapse of the lung.

For pediatric patients, a single-lumen tube is used with the tip placed into the contralateral mainstem bronchus.

For major lung resections, typed and crossmatched blood should be available.

Two large-bore intravenous lines and an arterial line should be also placed.

Thoracoscopic evaluation of an awake, nonintubated, nonventilated patient in an ambulatory setting under monitored anesthesia care has been described. [6]  Irons et al, in a study of 73 patients who underwent elective minor VATS, found nonintubated general anesthesia with spontaneous ventilation via a supraglottic airway device to be a feasible alternative to intubated general anesthesia. [7]

Positioning

The patient is turned to a full lateral decubitus position, and the operating table is flexed to widen the rib spaces on the operation side. The positions of the surgeon and assistant depend on the site of the pathology as suggested by preoperative imaging. The surgeon stands facing the site of the pathology, with the camera-holding assistant on the same side. The television monitor is positioned so that the surgeon, the site of pathology, and the monitor are aligned to allow the surgeon to look straight ahead when operating.

Alternatively, the patient can be positioned supine with a roll under his back to bump him or her up and provide access to the pleural space from a more anterior approach.

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